Rhinitis

Major modifiable risk factors for childhood food allergies include delayed introduction of solid foods and early treatment with antibiotics. James W. Mold, MD, MPH

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Importance: The incidence and risk (predictive) factors for early life food allergy development remain uncertain.

Objective: To estimate the incidence and quantify risk factors for food allergy development.

Data sources: MEDLINE and Embase were systematically searched to January 1, 2025. Data were analyzed from June 1, 2025, to November 25, 2025.

Study selection: Incidence estimates included studies confirming food allergy via food challenge. Risk factor analyses included cohort, case-control, and cross-sectional studies in any language assessing children younger than 6 years using multivariable analyses.

Data extraction and synthesis: Paired reviewers independently extracted data. Random-effects meta-analyses pooled incidence and adjusted odds ratios (ORs). Risk of bias was assessed using the QUIPS tool, and certainty of evidence assessed using GRADE.

Main outcome and measure: The primary outcome was food allergy to age 6 years.

Results: A total of 190 studies involving 2.8 million participants across 40 countries were analyzed. Among studies using food challenge, overall food allergy incidence was likely 4.7% (moderate certainty). Among 176 studies identifying 342 risk factors with varying certainty, the strongest and most certain factors included prior allergic conditions (eg, atopic dermatitis [eczema] within the first year of life [OR, 3.88; risk difference [RD], 12.0%; 95% CI, 8.8%-15.7%], allergic rhinitis [OR, 3.39; RD, 10.1%; 95% CI, 6.7%-14.4%], and wheeze [OR, 2.11; RD, 5.0%; 95% CI, 2.1%-8.8%]), severity of atopic dermatitis (OR, 1.22; RD, 1.0%; 95% CI, 0.6%-1.6%), increased skin transepidermal water loss (OR, 3.36; RD, 10.0%; 95% CI, 6.3%-14.8%), filaggrin gene sequence variations (OR, 1.93; RD, 4.2%; 95% CI, 2.4%-6.4%), delayed solid food introduction (eg, peanut after age 12 months [OR, 2.55; RD, 6.8%; 95% CI, 1.9%-14.6%]), infant antibiotic use (first month [OR, 4.11; RD, 12.8%; 95% CI, 0.4%-40%], first year [OR, 1.39; RD, 1.8%; 95% CI, 0.8%-3.1%], during pregnancy [OR, 1.32; RD, 1.5%; 95% CI, 0.6%-2.5%]), male sex (OR, 1.24; RD, 1.1%; 95% CI, 0.7%-1.6%), firstborn child (OR, 1.13; RD, 0.6%; 95% CI, 0.3%-1.0%), family history of food allergy (eg, mother [OR, 1.98; RD, 4.4%; 95% CI, 2.5%-6.8%], father [OR, 1.69; RD, 3.2%; 95% CI, 1.3%-5.5%], both parents [OR, 2.07; RD, 4.8%; 95% CI, 1.3%-5.5%], siblings [OR, 2.36; RD, 6.0%; 95% CI, 4.4%-8.0%]), parental migration (OR, 3.28; RD, 9.7%; 95% CI, 4.9%-16.3%), self-identification as Black (vs White [OR, 3.93; RD, 12.1%; 95% CI, 5.2%-22.5%], vs non-Hispanic White [OR, 2.23; RD, 5.5%; 95% CI, 3.0%-8.7%]), and cesarean delivery (OR, 1.16; RD, 1.0%; 95% CI, 0.3%-1.2%). Factors like low birth weight, postterm birth, maternal diet, and stress during pregnancy showed no significant risk difference.

Conclusions and relevance: In this meta-analysis, the most credible risk factors associated with development of childhood food allergy are a combination of major and minor risk factors, including early allergic conditions (atopic march/diathesis), delayed allergen introduction, genetics, antibiotic exposure, demographic factors, and birth-related variables.

Author/s:

Nazmul Islam, Alexandro W L Chu, Falana Sheriff, Farid Foroutan, Gordon H Guyatt, Romina Brignardello-Petersen, Paul Oykhman, Alfonso Iorio, Ariel Izcovich, Katherine M Morrison, Yetiani Roldan Benitez

Climate Change, Allergic Rhinitis, and Sinusitis

Megan George — Thu, 11 Dec 2025 22:13:48 +0000

Date Added:

December 11, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

December 3, 2025

URL:

Climate Change, Allergic Rhinitis, and Sinusitis

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2025.19748

Keywords

PMID (1):

41335404

MeSH

Important information regarding the increasing prevalence and management of patients with allergic rhinitis and chronic sinusitis as the climate changes. James W. Mold, MD, MPH

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Allergic rhinitis affects approximately 1 in 6 adults, and chronic rhinosinusitis (CRS) affects approximately 1 in 8 adults in the US.1,2 Climate change, due in part to rising global temperatures secondary to release of carbon dioxide (CO2) and other greenhouse gases, is a growing public health concern that affects many human organ systems, including the upper airway. Climate change affects sinonasal health directly by increasing aeroallergens and indirectly by changing weather patterns that result in drought-related dust, increased concentrations and stasis of air pollutants, worsening of wildfires,3 and heat-induced increases in ground-level ozone (O3). This JAMA Insights summarizes evidence regarding climate change, air pollution, and sinonasal health.

Author/s:

Duncan A. Meiklejohn, Neelima Tummala, M. Lauren Lalakea

What Parents Should Know About Allergic Rhinitis

Alex Haga — Tue, 04 Feb 2025 00:03:22 +0000

Date Added:

February 3, 2025

Journal/Publication:

JAMA

Publication Date:

February 3, 2025

URL:

What Parents Should Know About Allergic Rhinitis

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.5616

Keywords

Allergic rhinitis

rhinitis

children

PMID (1):

39869362

MeSH

Rhinitis

Allergic

Information for the parents of children regarding allergic rhinitis. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page discusses the symptoms, diagnosis, and treatment of allergic rhinitis in children.

Author/s:

Aparna Prasad, Jennifer L Thompson, Lindsay A Thompson

Ginger Extract Versus Loratadine in the Treatment of Allergic Rhinitis: A Randomized Controlled Trial

Brian Desmarais — Sat, 02 May 2020 20:13:25 +0000

Date Added:

May 2, 2020

Journal/Publication:

BMC Complimentary Medicine and Therapies

Publication Date:

April 20, 2020

Issue:

Volume:

Pages:

119

URL:

Ginger Extract Versus Loratadine in the Treatment of Allergic Rhinitis: A Randomized Controlled Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1186/s12906-020-2875-z

Keywords

MeSH

Ginger root extract, widely available online and in stores, appears to be as effective for allergic rhinitis as loratadine with fewer side effects. James W. Mold, MD, MPH

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Background: Allergic rhinitis (AR) is a non-infectious immune disease and incidents of the disease has continuously increased in Thailand. Ginger, a Thai herb, is used in food and Thai traditional medicine. This study was designed to assess efficacy and safety of ginger extract in comparison with loratadine for AR treatment.

Methods: AR patients were treated with ginger extract 500 mg (n = 40) against those treated with loratadine 10 mg (n = 40) in a randomized, double-blind, controlled trial for 3 and 6 weeks. The efficacy was evaluated from clinical examinations i.e. total nasal symptom scores (TNSS), cross-sectional area of the nasal cavity with acoustic rhinometry (ARM) and rhinoconjunctivitis quality of life questionnaire (RQLQ). The safety of treatment was measured by blood pressure, blood analysis and history-taking for side effects.

Results: The results showed both ginger extract and loratadine treated groups significantly decreased TNSS scores but there was no significant difference between the two groups. In acoustic rhinometry measurement, the ginger treated group significantly gradually increased the estimated volume of the nasal cavity and decreased distances from the nostril, but the loratadine treated group did not cause a change. Both groups gave significantly improvement in every aspect of the RQLQ at third weeks. The treatment with ginger extract was as safe as loratadine as shown by renal and liver function results obtained from blood analysis. Both treatments had no effect on blood pressure of the patients.

Conclusions: The ginger extract is as good as loratadine in improving nasal symptoms and quality of life in AR patients. However, ginger extract caused less side effects especially, drowsiness, fatigue, dizziness and constipation. Therefore, the ginger extract could be used as alternative treatment for patients with AR.

Trial registration: Registered with ClinicalTrials.gov (Registration number: NCT02576808) on 15 October 2015.

Keywords: Allergic rhinitis; Clinical trials; Ginger extract; Loratadine; Quality of life.

Author/s:

Yamprasert, R., Chanvimalueng, W., Mukkasombut, N., Itharat, A.